MEDICARE: EDINA KISHONTHY MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	48260	CA
2	106H00000X	Marriage & Family Therapist	1588	TN

General Provider Information

NPI Number	:	1245361211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDINA KISHONTHY MFT

Provider Business Mailing Address
First Line	:	445 SAVANNAH WAY
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2630
Country	:	US
Telephone Number	:	310-200-9739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 WESTGATE CIR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1300
Country	:	US
Telephone Number	:	615-745-1585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	10/22/2019

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